Optimizing HIV prevention for women: a review of evidence from microbicide studies and considerations for gender-sensitive microbicide introduction

Microbicides were conceptualized as a product that could give women increased agency over HIV prevention. However, gender-related norms and inequalities that place women and girls at risk of acquiring HIV are also likely to affect their ability to use microbicides.

Understanding how gendered norms and inequalities may pose obstacles to women’s microbicide use is important to inform product design, microbicide trial implementation and eventually microbicide and other antiretroviral-based prevention programmes. This study reviewed published vaginal microbicide studies to identify gender-related factors that are likely to affect microbicide acceptability, access and adherence.

Methods

Researchers conducted PubMed searches for microbicide studies published in journals between 2000 and 2013. They included microbicide clinical trials; surrogate studies in which a vaginal gel, ring or diaphragm was used without an active ingredient; and hypothetical studies in which no product was used.

Social and behavioural studies implemented in conjunction with clinical trials and surrogate studies were also included. Using a standardised review template, three reviewers read the articles and looked for gender-related findings in key domains:

product acceptability

sexual pleasure

partner communication

microbicide access and adherence

Results and discussion

The gendered norms, roles and relations that will likely affect women’s ability to access and use microbicides are related to two broad categories:

norms regulating women’s and men’s sexuality

power dynamics within intimate relationships

Though norms about women’s and men’s sexuality vary among cultural contexts, women’s sexual behaviour and pleasure are typically less socially acceptable and more restricted than men’s

Women’s limited power to negotiate the circumstances of their intimate relationships and sex lives will impact their ability to access and use microbicides

Men’s role in women’s effective microbicide use can range from opposition to non-interference to active support

Identifying an effective microbicide that women can use consistently is vital to the future of HIV prevention for women. Once such a microbicide is identified and licensed, positioning, marketing and delivering microbicides in a way that takes into account the gendered norms and inequalities we have identified would help maximize access and adherence. It also has the potential to improve communication about sexuality, strengthen relationships between women and men and increase women’s agency over their bodies and their health.